While the first provision of the Code of Ethics for Nurses addresses the need for compassion and respect for all individuals, the second provision identifies the primary concern of nursing care – the patient.
Provision 2: The nurse’s primary commitment is to the patient, whether an individual, family, group, community, or population.
Consider this scenario: Inmate James is in administrative segregation for attacking an officer. During medication rounds he tells the nurse that he needs to see the doctor about his sore wrist. It appears swollen and bruised. The segregation officer tells the nurse not to bother with this inmate as he is ‘scum’ and not worth the trouble. The nurse considers that the injury may have come from the recent fight with the officer. She knows she will get severe criticism from her officer peers if she initiates care for this patient.
The primacy of the patient as the focus of nursing care is a key component of nursing ethics. In fact, a nurse’s primary commitment is to the patient in all situations. This central focus allows ethical decision-making in situations where multiple loyalties may need to be considered, such as the case above. Ethical practice requires that the needs of a patient be given greater consideration than any competing needs of the employer, peers, and even ourselves.
The primacy of the patient stems from the therapeutic nature of the nurse-patient relationship. Unlike personal relationships that are bi-directional, benefiting both parties, the nurse-patient relationship is unidirectional and intended for the benefit of the patient; not the nurse.
Everyone at some time deals with competing loyalties. Whether to parents, employers, spouse, or friends; we can have conflicting priorities that must be weighed and sorted. Our loyalties have varying precedence depending on our role at the time. In the role of nurse, our loyalty to the patient must outweigh any conflicting loyalties that we might feel toward others such as an employer or colleagues.
In the example provided, it is understandable that the nurse would feel loyalty toward an officer peer; desiring to show support for the colleague who was attacked by this inmate. The therapeutic need of the patient, however, must outweigh that loyalty and requires the nurse’ attention.
Moral Courage Needed
It is not an easy job being a nurse and can be even more difficult being a correctional nurse. Moral courage is needed to overcome the fear of being ridiculed, ostracized, or unfairly treated for taking a patient-focused stand in a situation where dual loyalties exist. Here is some information for gaining and using moral courage in your nursing practice:
How about you? Are you challenged to keep the patient of central concern in your correctional practice? Share your thoughts in the comments section of this post.
This year I will be blogging regularly about the Code as I write a book to help correctional nurses apply the Code of Ethics in our challenging setting. Read all posts about the Code of Ethics here.